There's apparently a pretty standard procedure for applying for Social Security disability: you apply. They reject you. You appeal. Some unspecified period of time later, your appeals win, and you get to go on disability. This New York Times article has a pretty harrowing explanation of the process:
Of the roughly 2.5 million disability applicants each year now, about two-thirds are turned down initially by state agencies, which make decisions with federal oversight based on paper records but no face-to-face interview. Most of those who are refused give up at that point or after a failed request for local reconsideration.But of the more than 575,000 who go on to file appeals — putting them in the vast line for a hearing before a special federal judge — two-thirds eventually win a reversal.
Mr. Astrue and other officials attribute the high number of reversals to several causes. Those who file appeals tend to be those with stronger cases and lawyers who help them gather persuasive medical data. During the extended waiting period, a person’s condition may worsen, strengthening the case. The judges see applicants in person and have more discretion to grant benefits in borderline cases.
Requiring face-to-face interviews at the initial stage could reduce the number of appeals, Mr. Astrue said, “but given the huge volume of cases coming through, it would be incredibly costly, and the Congress is not willing to fund that.”
The growing delays in the appeal process over the last decade resulted in part from litigation and financing shortages that prevented the hiring of new administrative law judges. In addition, the number of applications is rising as baby boomers reach their 50s and 60s.
This is not quite as psychotic as it sounds. Disability is made deliberately difficult to apply for because the free rider problems in disability systems can be quite immense; by one estimate, from McKinsey, the actual Swedish unemployment figure is not 5% but 15%, after you take into account the working-age population who are on disability or in early retirement. Unless Sweden's much-vaunted kribbe-to-grav welfare state is somehow producing massive numbers of extra physical and emotional cripples, it's hard to escape the conclusion that some of these are people who could, if they wanted, hold down jobs.
Disability systems were originally designed to deal with conditions that were easy to evaluate--do you have two legs, or not? But they've been expanded to cover conditions such as depression and back pain that are literally in the minds of the patients: there is no way to detect malingering. In the 1970s, this gave rise to a number of well-publicised cases of able-bodied adults collecting disability. To prevent that, we've designed an application system that is preferable to working only if you really can't hold a job.
Despite what the article says, the boomers aren't a very good explanation for the rising caseload. Boomers are healthier than any previous generation, so much so that active life expectancy (ALE) is actually increasing faster than average life expectancy. Which is why, if you look at the data, you'll see that changes seem to be driven not by creaky knees, but by changes in awards for hard-to-verify categories like mental disorders. Just like in Sweden (although to a smaller extent), disability seems to be an increasingly popular substitute for unemployment insurance or welfare.
Of course, if you think the government should support more people, this is a feature, not a bug. But even if you don't, it's hard to see what should be done about this. Discouraging malingerers this way also entails immense suffering for the truly needy, who lose houses and hope while waiting for the government to relent.
Markets work. If you reward disability, disability comes forth. As if directed by an invisible crutch.
Why can't all depressed people just be like Gary Farber and have a successful blog and internet presence? What's wrong with them?
they've been expanded to cover conditions such as depression and back pain that are literally in the minds of the patients
Those of us who have dealt with this issue in the courts know that a diagnosis of spinal stenosis at L4-L5 is mandatory for the unsuccessful disability claimant. Usually, although not always, brought on by obesity.
On average a 60 year old baby boomer will be healthier then a 60 year old greatest generation member was 30 years ago. You are perfectly right.
But the number of 60 year olds going through the demographic bulge is much large now then the number of 60 year olds going through the system 5 years ago and the difference between todays 60 year old and the 60 year old 5 years ago is marginal.
Any good administrator, executive could see the rise in the case load emerging and worked to increase the ability to handle the larger case load.
Now, the relevant question is did the administrators appointed by the Bush administration deliberately ignore the coming bulge as a matter of policy? You know, so they can talk about how bad the government is. Or, the alternative explanation is that the Bush administration administrators are really that bad -- "great job Brownie".
Do you really believe that under a democratic administration that "wants government to work"
would have had the same problem.
If you put someone in charge who wants bad results why should you be surprised when you get bad results?
Oi! Megan, please, please, please TRY to understand SSA disability before writing a post. You've gotten a lot of basic facts about the system wrong:
(1) SSA will only grants old-term disability based on a strict criteria.
(2) It can take up to 3 years to get put on long term disability - an absolutely unacceptable amount of time considering the people we're talking about.
(3) The lag between determinations is based on two facts - (1) the chronic underresourcing of disability determination specialists; and (2) the fact that judges (with lifetime appointments) have shown little willingness to speed up their determinations.
(4) These mental disabilities typically are things like Autism, mental retardation, and Schizophrenia. And yes, this category is rising because we know more about these disorders and can better classify them, and in some cases, treat them.
(5) "back pain" is a loaded term. Most people think of the ordinary back stress everyone feels from time to time. SSA defines it as such things as herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture.
SSA retirement benefits arrive like clockwork because AARP would scream for the heads of Representatives and Senators in Congress if the administration of retirement benefits were inadequately funded. However, there is no disability lobby that aggressively pushes their Agenda like AARP. And how administrative resources for SSA are allocated definately shows this.
Personally, I find it unacceptable that people who PAID INTO the program then receive this kind of lousy treatment.
I also think you should probably spend a little more time, you know, researching this stuff before spouting off based on an article that fits your ideological lunch box of "SSA = BAD"
We need to hike capital gains taxes on the rich at least 100% so that we can invest in our real capital, OUR PEOPLE. DUH.
It is simple enough to solve this, just don't cover any form of "disability" that can't be objectively verified.
Personally, I find it unacceptable that people who PAID INTO the program then receive this kind of lousy treatment.
szr: What "lousy treatment" are you referring to? I didn't read any words of Megan or you documenting such. Sure, it must be a pain in the ass trying to get your claim approved, but if the government were not rigorous in its procedures surely fraud would increase.
Jasper,
The point, I think, is that the extra time doesn't go into extra rigor, it goes into letting the claim age in a cave like an overpriced cheese to a fully ripe maturity before getting around to deciding it.
And BTW, the judges in question aren't appointed for life, they're administrative law judges, not real district court judges. The real judges don't see it unless the ALJ turns it down and the claimant turns around an sues in federal court. That process is also very slow...
How about a Citizens' Basic Income? That would solve this problem.
It is somewhat amusing that the numbers of people claiming to be disabled increases at the same time as the percentage of jobs which are physically demanding decreases.
szr, from your comment, I'm unable to tell where it is that you think Megan disagrees with you.
I had a friend, an MD, who did disability evaluations for SSI.
She said their quota was something like 20 minutes per case. When she protested that 20 minutes was far too brief a time to read a medical file that might span years, reach a considered judgment as to whether the person was disabled within SSI standards, and dictate the ruling, she was told that was the rule, just do it. With that as a quota, it's not surprising they have so many reversals. And that those are persons who have the backing to retain an attorney and fight -- the rest probably wind up just accepting the ruling and lumping it.
The problem with SSI is that it's lumped in with Social Security for old people. While they're in a way the same thing -- welfare -- the government has sold us Social Security as a break-even system where people get back roughly what they paid in, like a pension. This has never been true, but people who would never accept welfare think an old-age pension is just dandy. So, the system works.
Disability, on the other hand, is naked wealth distribution. Someone permanently disabled at a young age will take well more than he ever pays in, and most people are ok with that. Supporting a disabled relative is a financial burden to a family, and the government's payments help out a bit. But this system, which is true welfare, should be separated from social secuirty pensions, which are not (wink, wink).
Disability is welfare for the deserving poor -- the blind, crippled, retarded, what have you. It should be administered as a part of TANF and Medicaid, to which it is more alike than SS.
Kyle, I agree with you in principle, and wish that were the practice.
SSA is the only organization that, in theory, has the administrative capacity to perform the program functions. Only Congress chronically underresource the administrative side of it (as Dave's not atypical case highlights) since the incentives are all stacked for retirement benefits.
It is simple enough to solve this, just don't cover any form of "disability" that can't be objectively verified.
Or simplify the application process for those forms of disability that can be verified.
Just to clarify: SSI (Supplemental Security Income) is means tested. It has both an income test and an assets test. It provides both a grant and Medicaid. The current federal benefit rate is $624 for an individual and $934 for a couple if the income is $0. Coverage requires the individual be aged, blind or disabled and unable to pursue gainful employment as a result. SSI is part of the general fund, not the Social Security part of the budget.
SSDI is not means tested. Eligibility if for those who are disabled and have worked 40 quarters. There is a two year wait for Medicare (not Medicaid.) The program is funded from the SS system, not the general fund.
The application process for disability is a joke and can be viewed as a jobs program for many lawyers and others who take a cut. Initial claims are typically done without legal assistance. Lawyers show up later because they get a cut of the back award on a percentage basis. The longer the case has festered the bigger the lawyer's fee. A lawyer who is involved in a slam dunk gets a percentage of a month or two of $624. Not a lot of incentive to get in early.
Disability for both programs is determined at the state level via a contracting agency. In Texas disability determination services are provided by the Texas Department of Assistive & Rehabilitative Services.
Do you think Sweden will survive? No chance. Read http://newsweden.wordpress.com